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West Virginia Medicaid Announces Reversal of Coverage Decision
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A recent change made by the Bureau of Medical Services affected many ENT Physicians who treat adult Medicaid patients as coverage for a number of CPT codes was denied for treatment of patients over the age of 21.
Due to strong advocacy by the WVSMA and our physician practices, the CPT codes that were changed to “non-covered” and denied as of February 1, 2011, will now be reversed and paid. According to Robin Brock, Program Manager for BMS, it was an oversight that these codes were not included on the original spreadsheet which was posted on the BMS website.
The Bureau of Medical Services says that the previously denied claims will be reprocessed by Molina and that payment should be forthcoming.
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Medicare News
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CMS has announced that Medicare contractors are holding claims for the Annual Wellness Visit until April 4, 2011.
The Centers for Medicare & Medicaid Services (CMS) has instructed all Medicare contractors to hold the Annual Wellness Visit (AWV) claims submitted on bills with dates of service on and after Jan. 1 through April 3.
According to the AAPC (American Association of Professional Coders), current editing prevents the billing of G0438 Annual wellness visit, including PPPS (personal prevention plan services), first visit and G0439 Annual wellness visit including PPPS, subsequent visit, if they are the only services on the claim. Claims containing the AWV along with other services are processing but the AWV service is not being paid.
CMS says the Medicare contractors' systems will be ready to process claims containing codes G0438 and G0439 no later than April 4, which is the official implementation date.
The Patient Protection and Affordable Care Act (PPACA) allows for payment under the Medicare Physician Fee Schedule (MPFS) for Annual Wellness Visits including personal prevention plan services (PPPS), effective Jan. 1, 2011. Medicare coinsurance and Part B deductibles do not apply.
Definitions relative to the AWV are included at Pub. 100-02, Medicare Benefit Policy Manual, chapter 15, section 280.5.
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AMA News
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The AMA is joining with other organizations in announcing the launch of a new online tool to provide all Americans with information on the health reform law so they can understand their options and make informed decisions. Physicians should find this to be a helpful resource when patients ask questions about the new law.
The web site, HealthCareandYou.org, is intended to be a reliable source of factual, easy-to-understand information. It features pages for 50 states and DC, where residents can learn more about health care in their state and see some of the coverage options available to them. It also allows visitors to personalize the information they access according to whether or they are over or under age 65, or if they are small business owners. As implementation of the ACA proceeds, more detailed information will be added, particularly with respect to the state-specific content.
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Palmetto GBA News
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Eligible Professionals Conference Call Scheduled!
On Friday Apr 1, from 1:30 – 3:00 PM, the CMS Provider Communications Group will host a national provider education call for eligible professionals about registration for the Medicare Electronic Health Records (EHR) Incentive Program, which will cover the following topics and have a question and answer session.
Eligibility for Incentives
Switching between the Medicare and Medicaid Incentive Programs
Reassigning Payments
Pre-Registration
Registration
Helpful Resources
In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation.
Registration will close at 1:30 p.m. ET on March 31, 2011, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
To register for the call participants need to go to: http://www.eventsvc.com/palmettogba/040111
Fill in all required data.
Verify that your time zone is displayed correctly in the drop down box.
Click "Register".
You will be taken to the “Thank you for registering” page and will receive a confirmation e-mail shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation e-mails. If you do not receive the confirmation e-mail, please check your spam/junk mail filter as it may have been directed there.
If assistance for hearing impaired services is needed the request must be sent to medicare.ttt@palmettogba.com no later than 3 business days before the event.
Prior to each call, presentation materials will be available in the Upcoming Events section of the Spotlight Page on the CMS EHR website.
Primary Care Incentive Payment Program (PCIP) Eligibility for New Providers Enrolled in Medicare
Effective July 1, 2011, the Primary Care Incentive Payment Program (PCIP) will be amended to include the participation of certain newly enrolled Medicare primary care physicians and non-physician practitioners who do not have a prior two-year claims history with which to determine eligibility. For more information, see the article:
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8EDNYD2658?opendocument
Primary Care Incentive Payment (PCIP) Eligibility Data Updated
Practitioners wishing to confirm PCIP eligibility for incentive payment year 2011 may now refer to the updated 'Primary Care Incentive Payment Eligibility' data files from CMS, available on the Palmetto GBA Web site.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~8EUJ3M0537?opendocument
Palmetto GBA Jurisdiction 11 Part B Web site: Now Live
The Palmetto GBA Jurisdiction 11 Part B (J11B) Web site is now live! Physician practices are encouraged to explore the site for information that will assist your practice or business in documenting services and filing accurate claims. http://www.palmettogba.com/palmetto/providers.nsf/ls/Jurisdiction%2011%20Part%20B~8EXJSQ6570?opendocument
April 2011 Medicare Advisory Is Now Available
The April 2011 Medicare Advisory for Ohio and West Virginia is now available. This issue is packed full of useful information for submitting Medicare Part B claims. Be sure to share the updates with the appropriate staff.
http://www.palmettogba.com/palmetto/providers.nsf/ls/OWV~7QGM2Z3677?opendocument
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WVU Schedules Palmetto GBA Seminar
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The West Virginia University Physicians of Charleston have announced that the annual Palmetto GBA Seminar will be held on April 26th. In order to better accommodate attendees' schedules, there will be 2 identical sessions: 9:00 am-12:00 (noon) and 1:00 pm-4:00 pm. This will be the Spring 2011 update and Palmetto will be discussing the Preventative Medicine changes, MAC update, CERT issues, and general updates.
If you plan to attend one of the sessions, you should RSVP to Laura Sullivan by April 15, 2011 at sullivanl@wvuhealthcare.com.
Participants will receive a certificate of attendance that will be sufficient to submit to your organization for 3 CEUs. This event is free of charge, and open to the public.
Please choose one of the sessions to attend:
Morning 9:00 am-12:00 (noon)
Afternoon 1:00 pm-4:00 pm
For additional information you may contact:
Laura Sullivan, RBA, CPC
West Virginia University Physicians of Charleston
Coordinator, Corporate Compliance Auditing and Education
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The Health Plan of the Upper Ohio Valley Update
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The Health Plan, licensed in Ohio and West Virginia, is expanding rapidly and anticipates being statewide in West Virginia during 2011. At this time, the Health Plan covers over 384 thousand lives.
Recent expansion totals include adding 24 new counties to their current service area, adding 23 West Virginia hospitals, 4 Virginia hospitals, 1103 physicians and 346 physician extenders. Meetings are scheduled with additional facilities as the Plan prepares to be statewide.
While the Health Plan credentials all mid-level providers, the still recognize “incident to” billing.
The Health Plan is fully electronic for claims, vouchers and EFT (electronic funds transfers). They have a filing deadline of 180 days and offer a “Gold Card” status for all new physicians.
The types of business lines that the Health Plan offers include Commercial, Government Programs and Employer Funded Plans. It is currently the only remaining Managed Care option for PEIA enrollees.
If you are interested in contracting with the Health Plan, you may contact Roxanne Loughery, Network Management Representative, at 1-800-598-3911 or via email RoxanneL@healthplan.org.
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Humana News
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(Humana is sending this information to physicians)
As part of Humana’s ongoing efforts toward claims process improvements, the plan is announcing that they will be updating their claim payment systems to better align with correct-coding initiatives, Centers for Medicare & Medicaid Services (CMS) guidelines, national benchmarks and industry standards. These changes will occur via a phased approach, with implementations on the following dates:
June 24, 2011 and November 5, 2011
Additionally, Humana has announced the following claims payment policy change:
On June 24, 2011, Humana will be implementing a new imaging procedure policy for Humana commercial products that impacts multiple radiological procedures performed during the same visit. First, the technical component of the claim will be paid at 100 percent for the first service, with a 50 percent reduction in the technical component for the second and subsequent services during the same visit. Secondly, Humana will apply the reductions anytime more than one service on the list of codes posted on our website, Humana.com/providers (choose “Claim Processing Edits” under the “Claim Resources” heading), is performed on the same date of service. No reduction will be applied to the professional component of the service, meaning that the professional component will be reimbursed at 100 percent for the first scan and any subsequent scans. Physicians should note that this is a change to the policy implemented in September 2005, and last revised January 1, 2007.
A detailed list of these changes will be available at Humana.com/providers 90 days prior to each implementation date. Choose “Claim Processing Edits” under the “Claim Resources” heading. The June 24, 2011, code edits were posted on March 25, 2011; the November 5, 2011, code edits will be posted on or before August 5, 2011. Please note that a notification letter will not be mailed prior to the November 5, 2011, code edits. All previously communicated code-editing changes are still applicable.
Humana’s goal is to consistently and accurately pay claims for more than 600,000 Humana participating network providers on behalf of our 10 million medical members nationwide. The plan is updating their claim payment systems to better align with the following industry standards:
1. American Medical Association (AMA) Current Procedural Terminology (CPT®) code sets
2. Healthcare Common Procedure Coding System (HCPCS) code sets
3. International Classification of Diseases, 9th Edition/Revision (ICD-9) code sets
4. Centers for Medicare & Medicaid Services (CMS) guidelines
If you would like additional information about the code-editing changes, please submit your question(s) via the “Code Editing Questions” application on the secure provider area of Humana’s website, Humana.com/providers, by following these steps:
On Humana.com/providers, select “Log In”
Enter your user ID and password and select “Log In”
Choose the “Claims Tools” tab
Select “Code Editing Questions” under “Associated Links” to submit your question(s)
In order to access the “Code Editing Questions” application, you must be registered on Humana’s website. If you haven’t registered, please follow these instructions:
On Humana.com/providers, select “Register”
Select “Provider” on the “Please tell us who you are” screen to start the provider registration process
Follow the instructions on the page as you move through the application process
Once the registration process is complete, you will be able to access “Code Editing Questions” and submit questions on the secure provider area of Humana.com/providers.
If you do not have access to the Web and you have questions about this information, or require a printed copy of the claim payment changes, please contact a Humana customer care representative at 1-800-4HUMANA
(1-800-448-6262).
The Humana Provider Network Operations Consultant for West Virginia is James “Jim’ Kelemen.
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Fortune Magazine Ranks UnitedHealthcare Number 1
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(information supplied by UnitedHealthcare)
Fortune Magazine has released its annual ranking of the most admired companies. UnitedHealth Group was ranked No. 1 among health care insurance and managed care companies. We were selected as the most admired in the overall category, and we were rated first in eight of the nine surveyed areas – innovation, people management, use of corporate assets, social responsibility, quality of management, financial soundness, long-term investment, and quality of products and services.
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CMOM Class Off to a Great Start!
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The 2011 Spring CMOM class is off to a great start! The class met last week for two days and will meet for 2 more days of class before taking the exam on Friday, April 1, 2011 (and that’s no April Fool!) Our excellent instructor, Maxine Collins, from Texas, has kept the class moving at a rapid pace.
The WVSMA commends the managers who are furthering their education through this important class. We also commend the physicians who have supported and encouraged their managers to seek additional knowledge and certification.
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Huntington OMA Schedules Meeting
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The Huntington Chapter of the West Virgina OMA will meet on Wednesday, April 13, 2011 at 11:30 AM for a Payor Seminar. The meeting will be held at St. Mary's Medical Center in room HC205.
Please contact President Pam Shaffer if you are interested in attending (pamela.shafer@camc.org).
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Charleston OMA Schedules Meeting
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The Charleston Chapter of the West Virginia OMA has scheduled a Spring Meeting on Thursday, April 14, at 11:30 AM in the Auditorium of the WVU Building beside CAMC Memorial.
The speaker for the meeting will be Bernie Deem, Owner and President of Deem HR. Bernie's topic will be "Who Do You Think You Are?"
OMA members may attend at no charge and non-members may attend for $20.00. Reserve your place now by contacting Connie Frazier (eyeconnie@gmail.com).
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Support Group Meeting Scheduled
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The newly formed West Virginia ANA (Acoustic Neuroma Association) Support Group will hold a Spring meeting on Saturday, April 9, 2011 at 11:00 a.m. at Shoney's in Kanawha City (3600 MacCorkle Avenue, S.E.; Charleston, WV).
The speaker will be Katheryn Monk, Au.D., CCC-A, an audiologist at Ear Nose & Throat Associates of Charleston. The meeting is open to ANA patients and family members.
For additional information, please contact Clarice Dalton (304) 744-5078 or thedaltons.739@gmail.com.
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March 30, 2011
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